Papers by Giovanni Merolla
Università degli Studi di Salerno Functional assesment of symptomatic snapping scapula after scap... more Università degli Studi di Salerno Functional assesment of symptomatic snapping scapula after scapulothoracic arthroscopy: a prospective study protocol
Infraspinatus scapular retraction test: a reliable and practical method to assess infraspinatus s... more Infraspinatus scapular retraction test: a reliable and practical method to assess infraspinatus strength in overhead athletes with scapular dyskinesis
Journal of Arthroscopy and Joint Surgery, 2021
Abstract Total shoulder arthroplasty is an effective procedure in restoring anatomy and biomechan... more Abstract Total shoulder arthroplasty is an effective procedure in restoring anatomy and biomechanics of the arthritic shoulder. It provides excellent clinical results, and its use is increasing worldwide. Glenoid loosening is the weak link in shoulder replacement, accounting for nearly one third of all total shoulder arthroplasty complications. Its causes and possible solutions have been object of extensive investigation. To strengthen glenoid fixation and provide long-term survival to the implant, several technical improvements have been proposed, different materials have been tested and various prosthetic glenoid designs have been developed, including cemented and uncemented all-polyethylene components, metal-backed, hybrid, inlay and augmented components. Thus, the surgeon has been provided with many options, but no clear superiority of one implant over the others has been proved. The choice of the right implant requires careful evaluation of patient’s pathology, anatomy and expectation and a thorough understanding of prosthetic shoulder biomechanics and of mechanisms of failure. The aim of this review is to discuss the available options for glenoid implants in TSA, describe the causes of failure and report author’s preferences in glenoid replacement.
Textbook of Shoulder Surgery, 2019
Shoulder instability encompasses a wide spectrum of clinical manifestations that range from painf... more Shoulder instability encompasses a wide spectrum of clinical manifestations that range from painful hyperlaxity to chronic locked shoulder dislocations. Correct diagnosis is critical to establish an effective treatment strategy. The biomechanics, clinical presentation, and management of shoulder instability are discussed and reviewed.
Translational Medicine @ UniSa, 2014
Principal investigator and promoter: Giovanni Merolla Co-investigator: Giuseppe Porcellini Invest... more Principal investigator and promoter: Giovanni Merolla Co-investigator: Giuseppe Porcellini Investigation performed at Biomechanics Laboratory “Marco Simoncelli”, D. Cervesi Hospital, Cattolica - Italy Plan of clinical investigation (PCI): Version 1.0 of December 10, 2012 Approved by AV/IRST Ethical Committee (Comitato Etico Area Vasta Romagna) Reg. Sperimentazioni 914 Prot. N°: 1785/2013/I.5/46
Reverse Shoulder Arthroplasty, 2018
The success of total shoulder arthroplasty (TSA) depends on recreation of normal shoulder biomech... more The success of total shoulder arthroplasty (TSA) depends on recreation of normal shoulder biomechanics using an anatomic prosthetic joint construct. Rotator cuff muscles play a vital role in shoulder dynamics by maintaining a stable centre of rotation. However, age-related rotator cuff degeneration is common and alters this biomechanics. Because of this reason, TSA has a higher failure rate when compared to arthroplasties of the other joints. Approximately 11% of TSA ends up in revision. Revision to reverse total shoulder arthroplasty (RTSA) predictably decreases pain and disability associated with failed TSA and improves function. RTSA in a revision setting is complex due to the bone defects and compromised soft tissues. This chapter elucidates the evaluation and management of a failed TSA.
Elbow Arthroplasty, 2019
Radial head arthroplasty is indicated in patients with complex pattern of radial head fractures. ... more Radial head arthroplasty is indicated in patients with complex pattern of radial head fractures. Restoration of radiocapitellar contact is a key point of the treatment. Capitellum wear due to the use of implant arthroplasty remains a concern. Several systems of classification have been described for radial head fractures, including injuries of bone and ligaments. Prosthetic models for radial head replacement can be divided into (1) silicone prostheses, (2) unipolar and bipolar, (3) monoblock and modular, (4) anatomical and non-anatomical, and (5) cemented and press-fit. Arthroplasty is indicated for Mason type III and IV radial head fractures. The goal of arthroplasty is the restoration of radiocapitellar stability, preservation of range of motion, and preservation of appropriate radial length in patients with complex radial head fractures.
Journal of Orthopaedics and Traumatology, 2021
The treatment of severe glenoid bone loss in shoulder arthroplasty represents a challenge, and th... more The treatment of severe glenoid bone loss in shoulder arthroplasty represents a challenge, and the results of current prosthetic designs with only glenoid fixation still remain unsatisfactory. In the past decade, customized glenoid prostheses have been developed to address severe glenoid arthritis and in the revision setting. In this review, we analyzed the current surgical options, the classification limits, past literature evidence, and our preliminary results of 6 patients (3 male, 3 female) treated with a reverse implant and custom-made glenoid implant (ProMade; LimaCorporate, Italy). Computer analysis of the residual shape and the amount of glenoid bone stock in association with new classifications could help the surgeon to obtain good clinical and radiological outcomes. The development of navigation systems could improve the adequacy of the implant and, thus, the reliability and longevity of the implant itself.
International Orthopaedics, 2020
Background We evaluated the pre-operative factors affecting anatomical and reverse total shoulder... more Background We evaluated the pre-operative factors affecting anatomical and reverse total shoulder arthroplasty (TSA and RTSA) indications in primary osteoarthritis and compared outcomes in patients aged 70 years and older. Methods Fifty-eight patients received a TSA with an all-polyethylene glenoid component (APGC) or an RTSA with/without glenoid lateralization and the same curved short-stem humeral component. Active anterior and lateral elevation (AAE, ALE), internal and external rotation (IR, ER), pain, and the Constant-Murley score (CS) were recorded pre and post-operatively. Preoperative rotator cuff (RC) fatty infiltration (FI) and modified Walch glenoid morphology were assessed. Humeral and glenoid component radiological outcomes were recorded. Results RTSA were older than TSA patients (p = 0.006), had lower pre-operative AAE (p < 0.001), ALE (p < 0.001), IR (p = 0.002), pain (p = 0.008) and CS (p < 0.001), and greater supraspinatus FI (p < 0.001). At a mean of 28.8 months, both implants yielded significantly different post-operative scores and similar complication rates. Both groups achieved similar post-operative AAE, ER, and IR; ALE was higher in TSA (p = 0.006); and AAE and ALE delta scores were higher in RTSA (p = 0.045 and p = 0.033, respectively). Radiolucent line rates were higher around the TSA APGC than the RTSA baseplate (p = 0.001). High-grade RC FI adversely affected mobility improvement. Humeral cortical thinning was significantly higher in TSA (p = 0.001). Conclusion RTSA patients were older, had poorer pre-operative active mobility, and had greater RC FI than TSA. Both devices provided good mid-term clinical and ROM improvement.
JSES Open Access, 2019
Methods: A multicenter prospective comparative study was led between May 2015 and May 2016. The I... more Methods: A multicenter prospective comparative study was led between May 2015 and May 2016. The Inclusion criteria were patients with irreparable PSMRCT managed by either APR or LDTT, and a minimal follow-up of 18 months. The Exclusion criteria were subscapularis tear and acromiohumeral distance < 6mm. The outcome measures were the Constant and Murley score, the active forward elevation and external rotation, the Quick-dash score and the subjective shoulder value (SSV). Results: eighty-two patients were included and analyzed at a mean followup of 21.8 months. The mean age was 65.5 years. Fifty-seven (70%) patients were managed by APR and 25 (30%) were managed by LDTT, depending on surgeon's preference. The active forward elevation increased from 134 ± 40 to 157 ± 27 in APR group (P<.05) and from 131 ± 40 to 142 ± 40 in LDTT group (P<.05), without significative difference between the 2 groups. The active external rotation was 31 ± 23 preoperatively and 32 ± 19 postoperatively in APR group and increased from 22 ± 24 to 36 ± 20 in LDTT group. The Constant and Murley score increased from 44 ± 19 to 65 ± 14 in the APR group, and from 39 ± 11 to 58 ± 18 in the LDTT group. The Quick-dash score improved from 62 ± 16 to 21 ± 18 in the APR group and from 63 ± 19 to 34 ± 23 in the LDTT group (P<.05). Conclusions: this prospective study confirms that APR and LDTT procedures improve clinical scores in patients with irreparable PSMRCT. Nonetheless, clinical scores are not better after LDTT compared with APR, except for the postoperative active external rotation.
LO SCALPELLO-OTODI Educational, 2018
Periprosthetic fractures in shoulder arthroplasty are a rare occurrence that has been rarely desc... more Periprosthetic fractures in shoulder arthroplasty are a rare occurrence that has been rarely described in the literature. Most of them occur during the surgical procedure, either owing to the surgeon's inexperience or to poor bone quality. Traumatic fractures affect patients with prostheses who suffer a direct trauma of the operated limb. It is important to assess the clinical presentation of the patient and the radiological findings for correct decision making. The factors that prompt the choice of treatment are primarily the type of fracture and stem stability. Once the decision has been made to proceed with either ORIF or revision of the implant, it is important to consider the quality of the rotator cuff in patients with hemiarthroplasty or total anatomic prosthesis, in order to consider an inverse implant. A long revision stem, accompanied by bone and cerclage, is always the most appropriate choice to restore function.
Arthroscopy, 2016
The glenohumeral joint is the most commonly dislocated joint in the body which can be attributed ... more The glenohumeral joint is the most commonly dislocated joint in the body which can be attributed to its highly mobile articulation. Although glenohumeral instability can occur in any direction, anterior instability is by far the most common, which ranges from subtle increased laxity to recurrent dislocation. Traumatic injury is the most common cause of shoulder instability, accounting for approximately 95 % of anterior shoulder dislocations [1]. In the successful management of traumatic anterior shoulder instability, the importance of patient history and thorough clinical examination supplemented with the radiological workup cannot be overemphasized. As these issues are effectively elaborated in the previous chapters, in this chapter, we will discuss about the indications, techniques, complications, and results of surgical management of anterior shoulder instability without glenoid bone loss.
MUSCULOSKELETAL SURGERY, 2015
ABSTRACT The purpose of this study was to look at the functional outcomes of arthroscopic repair ... more ABSTRACT The purpose of this study was to look at the functional outcomes of arthroscopic repair of anterosuperior rotator cuff tears. Sixty-one patients who underwent arthroscopic repair of anterosuperior cuff tears were retrospectively reviewed. At a minimum 6 months of follow-up, shoulder functional outcome scores including the Constant score (CS), simple shoulder test (SST) and visual analogic scale (VAS) were collected. Strength recovery for supraspinatus and subscapularis was investigated. All patients (mean age 59 ± 7) were available at a mean follow-up of 18 ± 7 months. The average CS improved from 30.8 ± 10.2 preoperatively to 76.5 ± 12.0 postoperatively, average SST from 2.6 ± 2.0 to 8.8 ± 2.9 and average VAS pain scale from 3.8 ± 1 to 0.5 ± 0.5 (p &lt; 0.0001). Strength at belly-press and Jobe tests significantly improved (p &lt; 0.0001). All patients with the exception of one were satisfied with the intervention. Arthroscopic repair of anterosuperior rotator cuff tears provides a significant improvement in pain relief and shoulder function. Strength recovery is demonstrated in medium correlation with tendon healing. Level IV, therapeutic case series.
La Chirurgia degli Organi di Movimento, 2008
More than 32.8% of the over-60s suffer from shoulder osteoarthritis. For advanced osteoarthritis,... more More than 32.8% of the over-60s suffer from shoulder osteoarthritis. For advanced osteoarthritis, arthroplasty is the treatment of choice. Current systems have moved on from the first shoulder prosthesis implanted by Neer in 1974, thanks to the use of adaptable modular systems. The aim of this study was to investigate the effectiveness of anatomical shoulder replacements in 30 cases of primary glenohumeral osteoarthritis through clinical and radiographic follow-up for a mean of 5 years. All implants were total cemented prostheses. Preoperative investigations included a clinical examination, conventional X-rays and CT. The Constant-Murley scale was used to evaluate the results; the mean score increased from 21.4 preoperative to 69.8 postoperative (p<0.05). In patients aged under 50, the increase in the mean postoperative Constant Score and ROM was greater than for the sample as a whole. The following complications were encountered: 2 postoperative radial nerve paralyses, resolving in 3 months, 2 cases of glenoid loosening, 1 periprosthetic fracture and 3 cases of pain and stiffness. The results led us to conclude that anatomical prostheses are effective in the treatment of severe primary glenohumeral arthropathy.
MUSCULOSKELETAL SURGERY, 2010
Glenoid wear following shoulder hemiarthroplasty (HA) has been reported around 80% in long-term f... more Glenoid wear following shoulder hemiarthroplasty (HA) has been reported around 80% in long-term follow-up studies. Radiographic analysis is useful to depict glenoid erosion but does not evaluate accurately glenoid bone loss. Multichannel computed tomography (MCCT) allows scanning with submillimeter section thickness through dense areas of glenoid bone, despite the presence of metallic prostheses. In this preliminary study, we performed a MCCT analysis of glenoid erosion, in 15 patients with painful shoulder HA, at an average follow-up of 5.5 years. Clinical scores were retrospectively assessed at an early (1 year), medium (2.5 years), and late (5.5 years) follow-up. We analyzed the following glenoid features: articular line space (ALS), glenoid length (bone stock), glenoid version, morphology of erosion (concentric, superior ed inferior tilt), and gross bone defects. Glenoid was retroversed in 13 patients (minimum 0°maximum 8°), antiversed in 2 patients (2°and 6°). Erosion was described as concentric in 13 patients, eccentric (''superior tilt'') in 1 patient, biconcave in another patient. The mean glenoid length was 19.7 mm (min 16.4 max 22.7). Gross bone defects were described in six patients. The scores registered at latest follow-up showed a significant decrease compared with the values at 1 year (P \ 0.001) and at 2.5 years (P \ 0.001). The patients with glenoid erosion associated with gross defects and ALS B1.2 mm had lower scores for pain and lower scores for ROM (P \ 0.01). Multidetector CT analysis establishes a new frontier in the postoperative management of shoulder arthroplasty, and its application in the glenoid analysis offers a significant contribution for the following reasons: qualitative and quantitative glenoid features are better seen because volume-rendering eliminates most streak artifacts and produces high-quality images; spatial information relative to the prosthetic devices and the relationship among hardware and bone can be better demonstrated; allows an accurate preoperative planning prior to starting with revision surgery.
MUSCULOSKELETAL SURGERY, 2014
Snapping scapula is characterized by crepitus between the scapula and the chest wall due to abnor... more Snapping scapula is characterized by crepitus between the scapula and the chest wall due to abnormal tissue at this site. Surgical treatment, when needed, may be either open or arthroscopic. The aim of this study was to evaluate prospectively the clinical outcomes of arthroscopic decompression in ten subjects with symptomatic snapping scapula. Ten subjects, five men and five women, mean age 24 years, were treated by arthroscopy after unsuccessful conservative management for 6 months. Clinical outcomes were evaluated with the Western Ontario Rotator Cuff (WORC) index, Constant-Murley score (CS), and simple shoulder test (SST). Follow-up was at 3 and 6 months; the final evaluation was conducted at a mean interval of 24 months. The final and preoperative X-rays were compared. The WORC index increased significantly at 3 (p &lt; 0.05), 6 (p &lt; 0.01), and 24 months (p &lt; 0.01). Similar outcomes were found for the CS at all 3 follow-up points (3 months, p &lt; 0.05; 6 months, p &lt; 0.01; 24 months, p &lt; 0.01). Mean &quot;yes&quot; responses on the SST were 9.8 ± 1.4 at 3 months (p &lt; 0.05), 10.2 ± 1.2 at 6 months (p &lt; 0.01), and 10.6 ± 1.2 at 24 months (p &lt; 0.01). X-ray examination depicted flattening of the anterior surface of the superior-medial angle of the scapula in the five patients who had had bone resection, whereas no significant difference with preoperative imaging was detected in the five patients who were managed by bursectomy and debridement alone. Arthroscopy is a feasible and minimally invasive treatment for painful snapping scapula syndrome. Comparative clinical trials are needed to collect conclusive data to state that it is the most suitable treatment for this condition.
The American journal of sports medicine, 2015
Hill-Sachs lesions are compression fractures that result from shoulder dislocation. They involve ... more Hill-Sachs lesions are compression fractures that result from shoulder dislocation. They involve "engaging" the humeral head on the anterior glenoid rim when the arm is abducted and externally rotated. The defect grows as the number of dislocations increases. Arthroscopic remplissage and anterior Bankart repair do not significantly affect infraspinatus strength while ensuring healing of the capsulotenodesis. Cohort study; Level of evidence, 3. Sixty-one patients with traumatic anterior shoulder instability treated by arthroscopic Bankart repair and Hill-Sachs remplissage at least 24 months previously were compared with a control group of 40 healthy participants. Preoperative imaging included magnetic resonance imaging for Bankart lesion identification and computed tomography to quantify the humeral head defect. Active range of motion and clinical scores (Walch-Duplay, Constant-Murley, and Rowe) were assessed. External rotation (ER) and internal rotation (IR) were measured ...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2014
The purpose of this study was to compare clinical and radiographic outcomes of open and mini-open... more The purpose of this study was to compare clinical and radiographic outcomes of open and mini-open arthroscopic arthrodesis. Methods: Twelve patients underwent arthroscopically assisted glenohumeral arthrodesis over a 5-year period; none were lost to follow-up. Surgery was performed with the patient in the lateral decubitus position, with the arm positioned in 30 each of flexion, internal rotation, and abduction. The articular cartilage was arthroscopically removed from the humerus and glenoid, creating flat opposing surfaces. One to 2 Kirschner wires were inserted percutaneously through the deltoid and across the glenohumeral joint in the center of the articulation; screws were then inserted arthroscopically. The glenohumeral joint was accessed through a mini-open posterior approach beneath the deltoid and was then reassessed before cannulated screws were tightened completely to compress the joint. Two dynamic compression plates were applied to the posterior glenohumeral joint to neutralize rotatory forces. Each patient was immobilized for 6 weeks. Follow-up radiographic imaging was performed at 2, 6, 12, and 24 months after surgery. These patients were then compared with a similar group who underwent a classic open approach. Success of arthrodesis was determined by bone growth across the glenohumeral joint as visualized on axillary radiographs. Results: At 2-year follow-up, complete fusion was achieved in 12 (100%) arthroscopically treated patients, with 2 patients (17%) having early bone grafting (within 6 weeks) through a percutaneous approach. Four patients in the classic open approach group ("open group") required additional grafting. Two patients in the group undergoing arthroscopic surgery ("arthroscopic group") had solid fusion but persisting infection from previously failed operations. Comparison of the 2 groups showed no difference in patient satisfaction or infection rates (2 in each group, all of whom had active infection at the time of the index surgery). One patient in the open group sustained a humeral shaft fracture 5 years after arthrodesis, which required additional surgery. No patient who underwent an arthroscopic procedure required additional surgery other than the 2 early bone grafts. Conclusions: Arthroscopically assisted mini-open glenohumeral arthrodesis provides results that are at least equal to those of open arthrodesis, with a much less invasive approach. Success and complication rates are the same as for the completely open procedure. Level of Evidence: Level IV, therapeutic case series.
MUSCULOSKELETAL SURGERY, 2010
A disturbance in scapulohumeral rhythm may cause negative biomechanic effects on rotator cuff (RC... more A disturbance in scapulohumeral rhythm may cause negative biomechanic effects on rotator cuff (RC). Alteration in scapular motion and shoulder pain can influence RC strength. Purpose of this study was to assess supraspinatus and infraspinatus strength in 29 overhead athletes with scapular dyskinesis, before and after 3 and 6 months of rehabilitation aimed to restore scapular musculature balance. A passive posterior soft tissues stretching was prescribed to balance shoulder mobility. Scapular dyskinesis patterns were evaluated according to Kibler et al. Clinical assessment was performed with the empty can (EC) test and infraspinatus strength test (IST). Strength values were recorded by a dynamometer; scores for pain were assessed with VAS scale. Changes of shoulder IR were measured. The force values increased at 3 months (P \ 0.01) and at 6 months (P \ 0.01). Changes of glenohumeral IR and decrease in pain scores were found at both follow-up. Outcomes registered on pain and strength confirm the role of a proper scapular position for an optimal length-tension relationship of the RC muscles. These data should encourage those caring for athletes to consider restoring of scapular musculature balance as essential part of the athletic training.
Simple and Complex Fractures of the Humerus, 2014
Proximal humeral head fractures account for 5 % of all fractures, and 20 % require surgical manag... more Proximal humeral head fractures account for 5 % of all fractures, and 20 % require surgical management. A small proportion of fractures managed conservatively and some of those managed by surgery may heal with malunion. These patients typically present with pain, impaired mobility, loss of strength, and stiffness and usually require further treatment. The diagnostic work-up to confirm a suspected malunited fracture of the proximal humeral head includes physical examination to assess length discrepancy and ROM reduction compared with the contralateral limb, cuff integrity, and brachial plexus nerves; X-rays; 3D CT; and MRI. A conservative approach is preferred in the absence of severe functional impairment or pain and in patients expected to achieve significant clinical improvement but does not relieve pain or improve the ROM in symptomatic patients. The main indications for surgical management are pain and ROM limitation; older age is associated with a higher rate of comorbidities and poor bone stock. Malunion is frequently associated with two-, three-, and four-part fractures. Treatment type is based on fragment size, degree of displacement, and ability to be removed. Treatment options envisage head preservation or replacement. Management with head preservation is done where feasible by arthroscopy, because it enables treating associated conditions. Prosthetic replacement is indicated when malunion has severely damaged the head joint surface resulting in incongruent articular surfaces or head necrosis. The outcomes of surgical management are a function of the correction of the bone problems and of soft tissue release. The risk of postoperative complications is high due to the complex nature of malunited proximal humeral fractures.
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Papers by Giovanni Merolla